2 Months to 4 Months

Feeding Baby "On Demand"

  • Once baby has regained birthweight (around 2 weeks of life), we stop feeding baby on a schedule.
    • Instead, wait until your baby "demands" to be fed.
      • In other words, wait until your baby is fussy to feed them.
      • Many babies will suck their hands or move their mouths, even when they aren't hungry yet.
    • If baby is awake and unhappy, first assume she is hungry.
      • If baby seems full, put her down on her back to make sure. If she cries when this happens, she needs more food. 
  • If baby refuses to eat and won’t stop crying no matter what you do, contact the pediatrician.

Development

  • If baby is awake and quiet, you can take the opportunity to help their development.
  • Babies only need two things for development at this age.
    • Tummy time
    • Hearing words from the people they care about.
    • Do these at the same time

Tummy Time

  • Do this when your baby is awake and happy.
    • Only do this during the day.
      • If baby is awake and happy during the night, try to get some sleep yourself!
  • Push up position on a firm, flat surface.
  • Keep baby’s head in midline. This forces your baby to work harder.
    • When they try to move the head to the side, simply reposition in the midline.
  • Do tummy time until baby cries. Feel the burn!
    • Most babies don't like tummy time at first, and this is completely normal.
    • Around 2 months of life, they begin to enjoy the tummy time. Keep practicing!

Milestone Goals for 4 Month Visit

  • The following assumes your baby was born on time.
  • If your baby was born early, you should base your expectations on her corrected age.
  • By 4 months, it's important that you've seen your baby roll from tummy time completely onto her back.
    • The only way to make this happen is tummy time, all the time.
    • If this hasn't happened by 4 months, we usually refer to physical therapy for extra help getting on track.
  • Puts hands in mouth
  • Smiles when you smile at her

Preventing Flat Head Syndrome

  • Some babies get flat heads, which may require a helmet to mold the head back to normal.
  • Tummy time whenever baby is awake and quiet.
  • Avoid excessive time in equipment such as bouncers, swings, floor chairs, etc.
    • Spending too much time here can contribute to head flattening.
  • Alternate which arm you hold baby with.

Teething

  • Around 3 or 4 months of life, babies find their hands and begin drooling a lot.
  • Parents sometimes think this means baby is teething.
  • In reality, these are just normal developmental milestones.
  • Most babies don't show teeth until at least 6 months of life.
  • A baby is not teething until you can feel teeth. Rub your finger along the gums and feel for sharp teeth breaking through.

Infant Sleep Patterns

  • Please see our guide to infant sleep in the first year of life for additional details.
  • Most brains start making melatonin around 8 weeks of life. This is the chemical that establishes our circadian rhythm and helps us sleep through the night.
  • At the 2 month visit, most parents are happy with how their baby is sleeping. If this is you, continue what you're doing. If it ain't broke, don't fix it.
  • If sometime between 2 and 4 months of life, your baby starts waking up every 1-2 hours throughout the night, I recommend doing four things.
    1. Always offer food first when this happens. The most likely reason is that she is hungry. If she eagerly finishes what you give her, offer more.
    2. Give her an early bedtime between 6-8pm, usually as close to 6pm as possible. Melatonin production peaks between 6-8pm, so putting her down for bed before this happens is the goal.
    3. Make the room so dark that you can't see your hands in front of your face. Sometimes this requires black trash bags over the windows. When any light enters the eye, it decreases melatonin production from the brain.
    4. Use a sound machine with white or brown noise. Don't use a timer. Make it run for the duration of overnight sleep.
  • Daytime naps occur at random until 3-4 months of life. At 2 months of life, you should not expect any pattern to the naps. As you approach 4 months of life, you can try the following:
    1. Make the room so dark that you can't see your hands in front of your face. Sometimes this requires black trash bags over the windows.
    2. Use a sound machine with white or brown noise. Don't use a timer. Make it run for the duration of overnight sleep.
    3. Put her down around 90 minutes after she wakes up in the morning and after each nap ends. This will ensure she is not overtired when you put her down. The goal is to put her down with a full tummy, in the perfect environment, and before she is overtired.

Just When You Think You Know Someone...

It's natural for new parents to pay close attention to their baby's daily patterns, and to get used to those patterns. Unfortunately, constant change is the rule, and just when you start getting used to your baby's habits and patterns, everything will change. Understandably, this surprises and worries parents if they aren't expecting it. It's important you know these changes are normal, there's nothing you did to cause them to happen, and there's nothing you can or should try to do to "fix" it.

Spitting Up

  • In the first 6 months of life, your baby's spit up patterns will change all the time.
    • Just when you get comfortable with these patterns, everything will change.
  • In the first 6 months of life, most babies spit up 20-30 times per day.
    • Most of the time they swallow it back down without you seeing it at all.
    • This occurs because the sphincter (think of a rubber band) that keeps food from leaving the stomach back to the mouth is loose in babies and gets tighter and stronger as they approach 6 months.
  • Normal Spit Up Includes:
    • A lot or a little
    • After every feed or just some of the feeds
    • 2 minutes or several hours after a feed
    • Clear, yellow, or the color of whatever they have been eating
    • Curdled or uncurdled
  • Spit Up is Not Caused By:
    • Eating too much (if you follow the hunger cues, you can’t overfeed a baby!)
    • Eating too fast
    • Not burping enough, or the baby being a “bad burper”
    • Mom’s diet
    • Putting them down too fast after a feed
    • Indigestion
    • Gas
  • What You Can Do
    • If your baby isn’t in pain while eating, this reflux is completely normal and should be ignored.
    • If you try to fix it, you won’t get the results you want, and you may create a new problem, such as feeding your baby less than she needs.
    • If it ain’t broke, don’t fix it!
  • Important
    • Your baby will not suffocate on their own spit up.
      • They will swallow it back down, or it will make a mess, but they will not choke to death if they spit up while lying on their back.
    • "Projectile" vomiting is a buzzword reserved pyloric stenosis, and it literally brings The Exorcist movie to mind.
      • This problem happens in 0.3% of children, usually happens around a month of life, and requires surgery to correct.
  • When To Worry
    • Your baby:
      • Is inconsolable 
      • Refuses to eat from the breast or the bottle
      • Becomes dehydrated
    • All babies have reflux, but a very small percentage of babies have painful reflux.
      • Babies with painful reflux have pain when they eat.
      • They show signs of hunger, and feed for a few sucks when offered food, but then scream in pain while eating, and refuse to eat anymore.
      • Sometimes these babies will lose weight due to painful eating, and may need medicine to reduce the acid in their stomachs so eating isn’t painful.

Poop

  • In the first year, your baby's pooping patterns will change all the time.
    • Just when you get comfortable with these patterns, everything will change.
  • From a medical standpoint, the poop is almost never important.
  • Poop Frequency
    • Your baby will go from pooping once a day, to pooping after every feed, and back again without warning.
    • Around a month of life, a baby’s digestive system becomes more efficient, and they may go 10+ days without pooping. 
  • Consistency
    • From little smears, to giant soupy blowouts, all consistencies are normal except:
      • Hard, little pellets/pebbles (think rabbit poop).
      • This is the way we define constipation in children.
  • Color
    • All the colors of the rainbow are normal, except for bright red blood.
    • White or "acholic" (without color) poop indicates a dangerous problem in children under 2 months old.
      • If older than 2 months of age, this is not concerning.
  • Odor
    • The odor of your baby's poop may change often, and is never a cause for concern.
  • Taste
    • Don't taste your baby's poop!
  • When to Worry
    • Bright red blood in the poop
    • Hard, little pellets/pebbles
    • Your baby:
      • is inconsolable
      • refuses to eat from the breast or the bottle
      • becomes dehydrated

Skin Rashes

  • In the 4 months of life, your baby may suddenly develop skin rashes.
    • Just when you get used to the appearance of their skin, everything will change.
  • These normal newborn rashes will spread and get smaller no matter what you do.
  • When to worry
    • Your baby:
      • is obviously itching at the rash throughout the day (even newborns will scratch at itchy skin).
      • has a fever in the first 90 days of life
      • is inconsolable
      • refuses to eat from the breast or the bottle
      • becomes dehydrated
      • develops respiratory distress

Nasal Congestion of the Newborn

  • Occurs between birth and 6 months of life
  • Unlike the runny nose caused by a cold virus, this congestion is something you hear in your baby, and is often accompanied with dried boogers in the nose you can see.
  • It’s important for you to know your baby does not have a cold when this occurs.
  • This is actually caused by silent reflux, which all babies and is completely normal.
  • The “boogers” you see and hear in the nose are actually dried breast milk or formula.
  • This is also the reason babies sneeze so much during the newborn period.
  • This congestion will not bother your baby, and almost never causes difficulty with feeding.

Eye Goop/Crusting

  • A blocked tear duct is a very common, non-infectious, cause of eye goop and crusting in the first ten months of life.
  • The tear duct normally drains tears when the eye makes them.
  • These ducts are small and easily blocked by debris during the first ten months of life.
  • When this happens, the tears don’t drain properly and accumulate into eye goop and crust.
  • The whites of the eye are not red, which lets you know there is no infection.
    • Wiping away the goop should be done sparingly (for example, if they can’t open the eye because of the crusting).
    • Wiping should only be done with sterile products to avoid introducing bacteria from tap water or a “clean” washcloth on your shelf.
    • Saline water and gauze are good options for wiping the goop if you need to. 
  • The blocked tear ducts usually come and go, often including both eyes, throughout the first ten months of life.